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One critique of many of the value-based program launched by CMS is that they have been voluntary. That self-selection clouds results, goes the critique, because hospitals (and physician practices) that elect to participate in a program likely have attributes going into the program that will make them successful. As a result, favorable outcomes or spending reductions may be misleading as a result.
But results reported in JAMA last week bya team of researchers led by Joshua M. Liao, M.D., M.Sc., of the University of Washington poked a hole in that critique and may color the debate about value-based programs. When Liao and his fellow researchers compared voluntary and mandatory bundled payment programs for hip and knee replacements, they found no difference in the spending reduction between the voluntary and the mandatory programs.